[ENT] Tonsillitis

Question 1

80% of pharyngitis cases are caused by?

Answer 1

viruses and are self-limiting

e.g. flu viruses, rhinovirus, coronavirus, RSV, EBV

Question 2

20% of pharyngitis cases are caused by?

Answer 2

bacteria and may require abx

e.g. group A/C/G strep, mycoplasma, chlamydia and gonorrhoea

Question 3

what are the features of infectious mononucleosis?

Answer 3

• fever
• wt loss
• maculopapular rash
• hepatosplenomegaly

Question 4

how does mild acute tonsillitis present?

Answer 4

• freely tolerates fluids

- not clinically unwell

Question 5

how is mild acute tonsillitis assessed?

Answer 5

• hx + exam

- Centor / FeverPAIN score (for abx guidance)

Question 6

how do you manage mild acute tonsillitis?

Answer 6

• self care advice +/- PO abx

- swab if persistent / recurrent case

Question 7

what are the components of the Centor criteria?

Answer 7

(+1 for each)

• age 3-14 (-1 point if >45)
• temp >38˚C
• tonsillar exudate
• cervical lymphadenopathy
• absent cough

Question 8

what are components of the FeverPAIN score?

Answer 8

(+1 for each)

• fever in the last 24 h
• purulent tonsilitis
• attended within 3 days
• inflamed severely (tonsils)
• no cough or coryza

Question 9

FeverPAIN 0-1

Centor 0-2

Answer 9

no abx advised

self care advice

Question 10

FeverPAIN 2-3

Answer 10

“back-up” abx prescription

self care advice

Question 11

FeverPAIN 4-5

Centor 3-5

Answer 11

abx prescription

self care advice

Question 12

what abx can be prescribed for tonsilitis and for how long?

Answer 12

phenoxymethylpenicillin (penicillin V) for 5 days

2nd line / penicillin allergic: Clarithromycin / Erythromycin for 5 days

Question 13

what are the features of moderate acute tonsillitis?

Answer 13

• unable to freely swallow fluids
• ‘hot potato voice’
• clinically unwell

Question 14

how is moderate acute tonsillitis managed?

Answer 14

• IV abx
• IV dexamethasone
• fluids + analgesia
• bloods + glandular fever screen
• drain quinsy if present

Question 15

after moderate acute tonsillitis is managed, what is done next?

Answer 15

observe for 3-4 hours, see if pt can tolerate fluids

Question 16

if the pt with moderate acute tonsillitis can now tolerate fluids after mx, what is done next?

Answer 16

discharge home with PO abx and PO steroids

Question 17

if the pt with moderate acute tonsillitis still cannot tolerate fluids after mx, what is done next?

Answer 17

continue abx + steroids

ENT referral

Question 18

what are the features of severe acute tonsillitis?

Answer 18

airway compromise with trismus → EMERGENCY!

Question 19

how is severe acute tonsillitis managed?

Answer 19

Emergency!

• high flow O2
• adrenaline nebs
• IV dex + abx
• bloods + glandular fever screen
• anaesthetic and ENT involvement

Question 20

what is Ludwig’s Angina?

Answer 20

severe cellulitis involving the floor of the mouth, where swelling develops rapidly → tongue is displaced superiorly and posteriorly, blocking the airway

Question 21

what are the causes of Ludwig’s Angina?

Answer 21

• deep neck space infections
• dental infection
• mandibular fracture

Question 22

what are the features of Ludwig’s Angina?

Answer 22

• trismus
• stridor
• bilateral neck swelling
• SOB

Question 23

how is Ludwig’s Angina managed?

Answer 23

urgent care with airway mx, IV steroids and abx

severe cases: I+D and intubation

Question 24

what is the role of steroids (dexamethasone)?

Answer 24

reduces swelling and inflammation → relieves trismus, allows easier eating and drinking and resolves a ‘hot potato’ voice

Question 25

drooling, stridor and tripod sitting in a toxic looking child. dx?

Answer 25

epiglottitis

Question 26

bilateral cervical lymphadenopathy, fever, myalgia and testicular swelling. dx?

Answer 26

mumps

Question 27

acrid/bitter taste in the mouth while eating, pain in the parotid/submandibular region. dx?

Answer 27

salivary duct stones

Question 28

what is the 1st line ix for acute tonsillitis?

Answer 28

oropharyngeal examination

in suspected tonsillitis, pharynx must always be visualised for erythema, swelling and exudate

Question 29

most common bacterial cause of tonisllitis?

Answer 29

strep pyogenes (group A strep)